Singing therapy for COPD

Chronic obstructive pulmonary disease(COPD) is a term used for a number of lung conditions that all affect ease of breathing, such as bronchitis and emphysema. COPD is a long-term disease that damages the airways, making them increasingly narrow, and thereby further obstructing airflow. Symptoms can be mild, including cough, phlegm, and shortness of breath during the winter or after a cold, to severe, with constant shortness of breath severely affecting daily activities. COPD cannot be cured, but it can be treated.

Patients with COPD often try to compensate for obstructed airways by changing the way they breathe. This may lead to stress on the respiratory muscles, while short, rapid breaths may cause an increased sense of panic, and exacerbate feelings of breathlessness.

A recent randomised controlled trial¹ looked at the effect of a 6-week singing course on the breathing patterns of patients with COPD. Patients who took part in the singing course showed significant improvements in their perceived quality of life as well as anxiety levels when compared to patients who didn't sing. When interviewed, 8 of the patients who took part in singing felt that it had a positive effect on their well-being, community support, achievement, and physical sensation.

In a larger study where a number of open singing workshops were offered, almost all of the 150 patients experienced the workshop as very enjoyable, and thought it had taught them how to breathe in a different way. The vast majority felt a marked physical difference after the workshop.

Therefore singing classes can improve the lives of patients with COPD, with a number of positive effects and no negative effects.

¹ Lord VM et al. Singing teaching as a therapy for chronic respiratory disease - a randomised controlled trial and qualitative evaluation. BMC Pulmonary Medicine 10:41 (2010)
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If you develop it, they will use it

Research from the department of "why didn't we think of that?": in research sponsored by Reckitt Benckiser Healthcare International Ltd, the treatment of pain with a tablet containing both paracetamol and ibuprofen was investigated.¹ These pain killers (analgesics) work in different ways, and therefore can be used together safely without causing overdose. Paracetamol, in contrast to ibuprofen, can accumulate in the liver when overdose occurs, and cause massive damage.

Volunteers were given either a combination paracetamol-ibuprofen tablet, or the two analgesics seperately. The combination pill showed a more rapid absorption of paracetamol, compared to paracetamol taken on its own. The mean blood concentrations of both paracetamol and ibuprofen were higher, earlier, than when the drugs were taken individually.

When the combined paracetamol-ibuprofen tablet was taken after a meal, absorption of ibuprofen was delayed by 25 minutes, and that of paracetamol was delayed by 55 minutes. The maximal blood concentration of both was also decreased when the tablet was taken after a meal. The study also determined that the combination tablet causes therapeutic dose levels of ibuprofen and paracetamol for approximately 12 hours when given three times per day. Therefore a combination paracetamol-ibuprofen treatment could provide enhanced pain relief for more severe pain.

Or, of course, you could just buy the two seperately, and take them together.




¹Tanner T, Aspley S, Munn A, Thomas T. The pharmacokinetic profile of a novel fixed-dose combination tablet of ibuprofen and paracetamol. BMC Clinical Pharmacology 10:10 (2010).
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The effect of drug use on pain tolerance

Research has shown that former opiate addicts that have been treated with methadone, and thereafter systematically taken off the methadone treatment, show decreases in brain function and abnormal pain thresholds.¹

A recent study tested the mental acuity of former opiate-dependent subjects before and after being exposed to a treatment that caused pain. The subjects were treated with a heat stimulus at their pain threshold. Their mental acuity was tested with a Stroop test. In this test you are instructed to name the colour that a word has been written in, when the word itself describes a colour (see image right).

Control subjects performed better than former opiate-dependent subjects in the Stroop test, when no pain was experienced. (Controls were never opiate-dependent and weren't exposed to methadone treatment either. ) In general, females performed better than males under these conditions. However, under painful conditions, male former opiate-dependent individuals showed a greater improvement in Stroop test scores than male control subjects or females of either group.

Therefore previous opiate dependence affects brain function, with males seemingly being more affected than females. However, response to pain is also altered, with males who were previously opiate dependent showing greater improvements in Stroop scores than females and control subjects.

¹Aniskin DB, MD; Fink E, MD; Prosser J, MD; Cohen LJ, PhD; Boda N, MD; Steinfeld M, MS; Galynker II, MD, PhD. The Effect of Pain on Stroop Performance in Patients With Opiate Dependence in Sustained Remission. Journal of Addiction Medicine doi: 10.1097/ADM.0b013e3181d77c07
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Swine flu treatment

In 2009 the Influenza A (H1N1) virus caused a global flu pandemic. It was commonly known as "swine flu" due to the presence of genetic elements from swine influenza. Recently a second occurrence of swine flu in India has claimed 13 lives, and continues to be a threat. ¹

Research underaken at Louisiana State University points to the usage of plasma exchange to treat patients with swine flu.² In these patients the disease reached severe proportions, being associated with inflammation of the lungs, shortness of breath, low blood-oxygen levels, and compromised circulation.

All the patients received three exchanges of blood plasma on consecutive days, showed no side effects, and survived despite the fact that the disease was expected to be fatal.

A critical key to the efficacy of this treatment was the already existent infrastructure that facilitated rapid response. This treatment provides an alternative when other treatments have been unsuccessful in addressing serious complications of swine flu.


¹ H1N1 vaccination drive for medical, para-medical staff launched. The Times of India: Aug 8, 2010.
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²Patel P et al. Use of therapeutic plasma exchange as a rescue therapy in 2009 pH1N1 influenza-An associated respiratory failure and hemodynamic shock. Pediatric Critical Care Medicine doi: 10.1097/PCC.0b013e3181e2a569 (2010)
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Prosthetic limbs

Recent TV coverage of the use of prostheses in animals^{1, 2} have brought to the attention the novel invention of the Intraosseus Transcutaneous Amputation Prosthesis (ITAP).³

Traditional prostheses are attached to limb stumps by straps or other attachment methods. Therefore the stump, covered in soft tissue and skin, presses on the prosthesis. This can lead to a number of complications, such as pressure sores. These prosthetics can also be quite inefficient if the muscles that move the prosthesis are active far away from the prosthesis.

The ITAP was developed by researchers at University College London to address these issues. The ITAP prevents trauma to soft tissues by redistributing stress to the bone. However, the ITAP creates a breach in the skin's protective barrier to infection - therefore a method was required to prevent infection from occurring around the entry point of the prosthesis. The ITAP was therefore modelled on deer antlers, as antlers represent bone that grows out of a skin base, without infection occurring (Fig. 1).






The research group developed a pin that could be inserted into bone, and which had an external peg to which a prosthetic limb could be attached (Fig. 2). The surface of the pin is shaped with grooves to prevent rotation in the bone (Fig.2: 1), and also treated with a substance such as hydroxy apatite (a form of calcium phosphate), to encourage integration into the bone. The middle section of the pin consists of a flange (Fig.2: 4) that which forms a link between the bone and the epithelial surface of the soft tissue surrounding it. This flange has a porous coating (Fig.2: 6) to encourage soft tissue growth. This can further be promoted by treating the surfaces with adhesion-promoting proteins, such as fibronectin or laminin. The implant attaches directly to the skin at this point - something that has never been done before. A successful seal between the implant and the skin prevents infections. The exterior peg (Fig.2: 5) is treated with a diamond-like carbon layer that prevents the adhesion of micro-organisms, further reducing the risk of infection.

The ITAP was first used in a clinical trial in 2005 in a woman who had lost a thumb due to a bite from a horse.⁴ ITAP products have been used for the prosthetic replacement of 12 fingers and thumbs, 1 arm, 2 legs, and 5 craniofacial bones in humans, and for the replacement of thoracic and pelvic limbs in a number of cats and dogs (see a photo⁵ of Coal, an American Bulldog who received an ITAP at Fitzpatrick Referrals).











¹ http://www.bbc.co.uk/programmes/b00syxlx
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² http://www.fitzpatrickreferrals.co.uk/
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³ Blun G et al. Transcutaneous prosthesis. US patent 7014661
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⁴ http://www.ukti.gov.uk/investintheuk/sectoropportunities/lifesciences/localisation/110831.html (2010)
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⁵ Fitzpatrick N. Intraosseous Transcutaneous Amputation Prosthesis. The SPVS Review pp43-52 (2009)
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Obesity - disease or lack of willpower?

Debate rages over whether obesity is caused by lifestyle or is actually a disease.

A lot of research has pinpointed genetic factors that are associated with obesity and even some behaviours. Certain changes in DNA are strongly correlated with the incidence of obesity, such as the deletion of DNA from chromosome 16¹ and specific changes in single nucleotides in 13 different genes in the human genome.² A research group in Spain has found a strong association between single nucleotide polymorphisms (SNPs) in a gene related to the circadian clock³, and cessation of a weight-reduction program. These SNPs were also associated with extreme snacking, eating when bored, skipping breakfast, and abdominal obesity.

The value of this research lies in the potential to tailor weight-loss programs to the individual. At the Nutrition, Physical Activity, and Metabolism 2010 conference held in March in San Francisco, data was presented showing that people responded better to diets when these diets were assigned based on their genotype, instead of randomly.⁴

Subjects were put on either the Atkins, Ornish, Traditional, or Zone diets, and the presence of specific forms of three different genes were determined. There was a strong and significant correlation between certain genotypes, a specific weightloss regime, and amount of weight lost. The proportion of people who responded well to low-carb diets compared to those who responded well to low-fat diets was approximately 50-50.

So your genes might tell you whether you're predisposed to gaining weight. It can also help you to choose strategies to manage weight loss. Increasing knowledge of the links between genes and disease allow for the development of more sophisticated drugs and treatments.

¹Walters R.G. et al. A new highly penetrant form of obesity due to deletions on chromosome 16p11.2. Nature 463, 671-675 (2010).
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²Cheung C.Y.Y. et al. Obesity Susceptibility Genetic Variants Identified from Recent Genome-Wide Association Studies: Implications in a Chinese Population. The Journal of Clinical Endocrinology & Metabolism 95: 1395-1403 (2010).
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³Garaulet M. et al. PERIOD2 Variants Are Associated with Abdominal Obesity, Psycho-Behavioral Factors, and Attrition in the Dietary Treatment of Obesity. Journal of the American Dietetic Association 110: 917-921 (2010).
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⁴O'Riordan M. Dieting by DNA? Popular diets work best by genotype, research shows. Heartwire (2010)
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Antibody therapy

Ron Levy, professor of Medicine at Stanford University, is the man who took the first steps in the development of antibodies as a therapy.¹ In 1976 Dr. Levy discovered that antibodies can be made in the lab that will identify and bind to cancerous cells, triggering an immune response that destroys the cancerous cells. His initial work focused on creating tailor-made antibodies for use in individual patients, but as this would be unfeasible at an industrial level, the treatment was developed into a large-scale drug. This drug didn't target only cancer cells, but targeted all B-cells of the immune system. The results were surprising, as people did very well despite having their bodies depleted of B-cells - cells that form a significant part of the immune system. This drug is marketed under the name "Rituximab" or "Rituxan".

Rituximab works by identifying a specific protein on the outside of B-cells, called CD20.² When Rituximab binds to CD20, the body's immune system is triggered, leading to the destruction of that B-cell. Since Rituximab doesn't distinguish between cancerous and non-cancerous B-cells, all B-cells in the body are targeted. This therapy has a number of serious potential side-effects, but is attractive to use since it doesn't cause the nausea and malaise caused by other treatments like chemotherapy. It can also be used repeatedly if relapse occurs, with improved response at each consecutive treatment.

Rituximab has been used successfully in the treatment of lupus³, rheumatoid arthritis⁴, and in transplants to prevent rejection of transplanted tissue.⁵

Since the development of Rituximab, a large amount of research has been done on the usage of antibodies to treat various cancers and diseases. As can be seen from the illustration below, antibody therapies have been developed to treat blood-related cancers (hematologic malignancies) and solid tumors, targeting a number of surface proteins on B-cells. There is an excellent review on the topic of antibody therapies, their development and application, as well as their potential use in the targeting of influenza virus here.<sup>6



1</sup> http://stanmed.stanford.edu/2004fall/levy.html
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²Pescovitz M.D. Rituximab, an Anti-CD20 Monoclonal Antibody: History and Mechanism of Action. American Journal of Transplantation 6:859-866 (2006).
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³ Eisenberg R. SLE - Rituximab in lupus. Arthritis Res Ther. 5: 157–159 (2003).
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⁴ http://www.rituxan.com/ra/patient/index.xhtml
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⁵ Salama A. and Pusey C.D. Drug Insight: rituximab in renal disease and transplantation. Nature Clinical Practice Nephrology 2: 221-230 (2006).
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⁶ Guzmán F. Overview on monoclonal antibody therapy: PPT, images and videos. Pharmacology Corner http://pharmacologycorner.com/overview-on-monoclonal-antibody-therapy-ppt-images-and-videos/
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